*Respiratory drugs

Question 1

Basics of respiratory diseases

Answer 1

• Asthma is a chronic disease characterized by hyper-responsive
  airways
• COPD includes emphysema and chronic bronchitis and is
  currently the 4th most common cause of preventable deaths in
  the US
• Allergic rhinitis, characterized by itchy, watery eyes, runny nose,
  and a nonproductive cough, is an extremely common condition
• Accumulation of mucus is common in COPD and CF

Question 2

RESPIRATORY THERAPY DRUG CLASSES

Answer 2

• Leukotriene Inhibitors
• Beta-2 Agonists
• Muscarinic Receptor Antagonists
• Steroidal Anti-Inflammatories
• Mucolytics/Expectorants

Question 3

Examples of leukotrine inhibitors

Answer 3

• Montelukast
• Zafirlukast

Question 4

Indications of Montelukast

Answer 4

• Asthma maintenance
• Bronchospasm, exercise induced
• Allergic rhinitis:

Question 5

Mechanism of actoin of montelukast

Answer 5

• Selectively binds to airway cysteinyl leukotriene receptors
  blocking their stimulation by their endogenous ligands (LTC4,
  LTD4, LTE4) which are released by mast cells and eosinophils

Question 6

Adverse reactions of montelukast

Answer 6

Adverse Reactions

• Common:
  
  • headache, flu-like symptoms, pruritus, rash, restlessness
• Serious:
  
  • hematology: thrombocytopenia
  • Hypersensitivity: erythema nodosum, angioedema

Topical Ophthalmic Drug Interactions

• None

Contraindications/Cautions

• No applicable ophthalmic conditions or findings

Question 7

Asthma therapy

Answer 7

Question 8

BETA-2 AGONISTS used in the treatment of asthma

Answer 8

• Short-Acting
  
  • 7 Albuterol aka Salbutamol
  • Levalbuterol aka Levosalbutamol
  • Metaproterenol
• Long-Acting
  
  • Formoterol
  • Salmeterol

Question 9

Indications of Albuterol(Salbutamol)(B2 agonist)

Answer 9

• Bronchospasm
• Acute bronchospasm
• Exercise-induced bronchospasm

Question 10

Mechanism of action of Albuterol(Salbutamol)

Answer 10

• Selectively stimulates β2 adrenergic receptors causing
  relaxation in airway smooth muscle

Question 11

Adverse reactions of Albuterol(Salbutamol) (B2 agonist)

Answer 11

Adverse Reactions

• Common:
  
  • cough,
  • dizziness,
  • headache
• Severe:
  
  • Respiratory: paradoxical bronchospasm
  • CVS: hypertension, angina, MI, arrhythmias

Topical Ophthalmic Drug Interactions

• None

Cautions

• Hypertension
• Diabetes mellitus

Question 12

Exxamples of MUSCARINIC RECEPTOR ANTAGONISTS

Answer 12

• Long-Acting Muscarinic Antagonist (LAMA)
  
  • Tiotropium [Spiriva Handihaler®, Spiriva Respimat®]
• Short-Acting Muscarinic Antagonist (SAMA)
  
  • Ipratropium [Atrovent HFA®]

Question 13

Indications of triotropium

Answer 13

• COPD
• Asthma

Question 14

Mechanism of action of triotropium

Answer 14

• Antagonizes acetylcholine receptors producing
  bronchodilation
• (long acting muscarinic antagonist)

Question 15

Adverse reactions of triotropium

Answer 15

• Common:
  
  • cough,
  • dizziness,
  • headache
• Severe:
  
  • Ocular: Angle-closure glaucoma

Topical Ophthalmic Drug Interactions

• None

Cautions

• Angle-closure glaucoma

Question 16

Indications for the use of FLUTICASONE(steroid)

Answer 16

• Acts through classic steroid pathway inhibiting arachidonic
  acid-based eicosanoid production

Combination of fluticasone & salmeterol indicated for COPD and asthma maintenance

Question 17

Advrese reactions of fluticasone

Answer 17

• Common:
  
  • headache,
  • cough,
  • pyrexia,
  • epistaxis
• Severe:
  
  • Hormonal: adrenal suppression, hypercorticism,
    pediatric growth suppression
  • Nasal: nasal/oral candidiasis, nasal ulcer or septal
    perforation
  • Ocular: cataracts, glaucoma, elevated IOP

Question 18

Mechanism of action of salmeterol(long acting B2 agonist)

Answer 18

• A chemical analog of Albuterol having a lipophilic side chain
  that enhances duration of action; like Albuterol, this β2 Agonist
  produces relaxation of airway smooth muscle

Question 19

Adverese reactions of salmeterol(B2 agonist)

Answer 19

• Common:
  
  • headache
• ​Severe:
  
  • Hypersensitivity: anaphylaxis, angioedema
  • Respiratory: paradoxical bronchospasm, asthma
  • CV: arrhythmia, HTN

Question 20

ADVAIR DISKUS (salmeterol/fluticasone combo) cautions for use

Answer 20

• Hypertension
• Diabetes mellitus
• Active infection
• Ocular: HSV infection, glaucoma, cataracts

Question 21

Indications for momentasone (steroid nasal spray)

Answer 21

• Allergic Rhinitis
• Nasal Polyp Therapy

Question 22

Mometasone mechanism of action

Answer 22

• Steroid
• Inhibits multiple inflammatory cytokines; produces multiple
  glucocorticoid and mineralocorticoid effects

Question 23

Adverse reactions of mometasone(steroid)

Answer 23

• Common: Headache, viral infection, epistaxis
  
  • Ocular: conjunctivitis
• Serious:
  
  • Sinus: Septal perforation, ulcer, candidiasis
    Ocular: Elevated IOP, glaucoma

Topical Ophthalmic Drug Interactions

• None

Cautions

• Ocular: HSV infection, glaucoma, cataracts

Question 24

Examples of mucolytics

(maak slym los)

Answer 24

• Guaifenesin [Mucinex®]
• Acetylcysteine (Acc 200)

Question 25

Indications of guaifenecin

Answer 25

* Expectorant

Question 26

Mechanism of action of guaifenecin

Answer 26

* Increases volume/decreases viscosity of respiratory tract secretion

Question 27

Indications of acetylcysteine

Answer 27

* Mucolytic: individualized nebulizer dosing, 200 mg PO bid-tid * Acetaminophen Overdose (paracetamol overdose)

Question 28

Mechanism of action of acetylcysteine

Answer 28

* Breaks disulfide bonds, decreasing mucus viscosity * Overdose: \*Replenishes glutathione, facilitating non-toxic metabolism of acetaminophen

Question 29

Adverse reactions of acetylcysteine

Answer 29

Adverse Reactions * Common: * Flushing, * pruritus, * tachycardia Topical Ophthalmic Drug Interactions * None Contraindications/Cautions * No applicable ophthalmic conditions or findings